title: Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles.
  
  
  OBJECTIVE
  We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS.
  
  
  METHODS
  Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011.
  
  
  METHODS
  We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects.
  
  
  METHODS
  Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible.
  
  
  RESULTS
  We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamide users. Indirect evidence from populations without PCOS demonstrated no increased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), and increased relative risk difference of venous thromboembolism with oral contraceptive pills but very low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive.
  
  
  CONCLUSIONS
  Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.
authors.affiliation: MD, MPH, Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Murad.mohammad@mayo.edu.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Domecq
authors.forename: Gabriela
authors.initials: G
authors.lastname: Prutsky
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullan
authors.forename: Vishnu
authors.initials: V
authors.lastname: Sundaresh
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Corrine
authors.initials: C
authors.lastname: Welt
authors.forename: David
authors.initials: D
authors.lastname: Ehrmann
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000009:adverse effects* / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005485:Flutamide / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000209:etiology
chemical_list: D000726:Androgen Antagonists; D003276:Contraceptives, Oral; D007004:Hypoglycemic Agents; D005485:Flutamide; D008687:Metformin